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A "looming crisis" faces the world of nuclear medicine, as unexpected shutdowns at nuclear reactors producing vital medical isotopes are seriously affecting world supplies, according to reports. Experts in the field are calling for concerted international action to stop such events happening again.

All five of the world's main medical isotope producing reactors shut down last week for unrelated reasons. Some of the outages were planned, but others weren't. In particular, the High Flux Reactor facility at Petten in the Netherlands went down unexpectedly. This is seen as particularly serious, as all other facilities producing Molybdenum-99 (Mo-99) - the most widely-used isotope in nuclear medicine - were already offline.

According to the Society for Nuclear Medicine (SNM), "there is a distinct possibility that worldwide production of Mo-99 could completely cease for a prolonged period, with devastating results". The problem is especially serious as Mo-99 can't be stored, having a half-life of just 66 hours: it has to be produced as required.

"This could be described as a perfect storm in isotope availability," said Robert W Atcher, emerging-medical-tech chief at the US Los Alamos national lab and SNM president.

"A combination of anticipated outages at other production reactors, coupled with unanticipated shutdowns, is simply devastating... Following the shutdown of Canada's Chalk River facility late last year, we simply cannot afford to sit and wait as the situation continues to worsen."

Isotopes such as Mo-99 are used in diagnostic techniques, where they are taken into the body by injection or ingestion and absorbed by certain body cells and tissues. Technicians can then track the cells' movement by the trace radioactivity the isotopes give off. The isotopes are seen as essential tools against various kinds of cancer, nervous diseases like Alzheimer's and Parkinson's and cardiac complaints.

The Chalk River plant in Canada - which supplies about half the world's medical isotope needs - was eventually reopened on government orders following safety disputes last year, but is currently undergoing a planned shutdown. It's expected to re-open this week, but reports indicate that there will still be shortages of supply due to the unexpected outage at Petten.

"We are going to try produce enough to narrow the gap, but certainly, we won't be able to produce the global demand," a Chalk River spokesman told the Vancouver Sun, following the news from the Netherlands.

According to the SNM, efforts to reduce proliferation of nuclear weapons and/or "to deter terrorism" are hindering moves to stabilise the world medical isotope supply. Worries over the use of highly-enriched uranium, which can be of use in nuclear bomb programmes, have meant that the US is completely dependent on imported isotopes. Medical radioisotopes are also often seen as likely materials for production of so-called "dirty bombs" by terrorists; devices which would not cause a nuclear explosion but would scatter radioactive material by other means. Though the actual threat to life and health from medical-supplies-based radioactivity attacks is seen by most analysts as slim to nonexistent, it's argued that such tactics could cause serious panic and alarm.

All this has led to many barriers being placed in the path of new isotope production capacity. Though the world's existing facilities do try to coordinate their maintenance efforts, there's sometimes insufficient capacity to deal with the unexpected - and international cooperation isn't sufficiently robust.

"This is a serious problem," said Michael Graham, SNM President-Elect. "Now, more than ever, it is critical that the United States, along with other countries, take the lead on recommending alternatives to ensure consistent access to mission-critical isotopes, which are essential to hospitals and their ability to provide patient care." ®